With advances in surgical and anesthesia techniques, peri-operative mortality has markedly decreased. Presently cardiac complications are the most common cause of death. Clinical criteria and complexity of planned surgery predict the risk for adverse cardiac events. Only select patients require further evaluation such as stress testing for risk stratification. Coronary revascularization prior to surgery has not been shown to reduce the risk of cardiac events. Beta adrenergic blockers are beneficial when used with proper precautions. Management of anti-platelet and anticoagulant therapies during the peri-operative period will be described.